The role of environmental factors in search and rescue incidents in Nunavut, Canada.

OBJECTIVES: Unintentional injury is a leading cause of morbidity and mortality in Nunavut, where the importance of land-based activities and reliance on semi-permanent trails create unique risk profiles. Climate change is believed to be exacerbating these risks, although no studies have quantitatively examined links between environmental conditions and injury and distress in the Canadian Arctic. We examine the correlation between environmental conditions and land-based search and rescue (SAR) incidents across Nunavut. STUDY DESIGN: Case study. METHODS: Case data were acquired from the Canadian National Search and Rescue Secretariat. Gasoline sales from across the territory are then used to model land-use and exposure. We compare weather and ice conditions during 202 SAR incidents to conditions during 755 non-SAR days (controls) between 2013 and 2014. RESULTS: We show daily ambient temperature, ice concentration, ice thickness, and variation in types of ice to be correlated with SAR rates across the territory during the study period. CONCLUSIONS: These conditions are projected to be affected by future climate change, which could increase demand for SAR and increase injury rates in the absence of targeted efforts aimed at prevention and treatment. This study provides health practitioners and public health communities with clearer understanding to prepare, respond to, and prevent injuries across the Arctic.

The cost and effectiveness of adherence-improving interventions for antihypertensive and lipid-lowering drugs*.

AIMS: Adherence to cardiovascular medications is poor. Accordingly, interventions have been proposed to improve adherence. However, as intervention-associated costs are rarely considered in full, we sought to review the effectiveness and costs associated with different adherence-improving interventions for cardiovascular disease therapies. METHODS: We reviewed MEDLINE to update a prior review of interventions to improve adherence with antihypertensive and/or lipid-lowering therapy covering January 1972 to June 2002, to add studies published from July 2002 to October 2007. Eligible studies evaluated > or = 1 intervention compared with a control, used measures other than self-report, reported significant improvement in adherence and followed patients for > or = 6 months. Effectiveness was measured as relative improvement (RI), the ratio of adherence in the intervention group to the control group. Costs were calculated based on those reported in the analysis, if available or estimated based on resource use described. All costs were truncated to 6 months and adjusted to 2007 US$. RESULTS: Of 755 new articles, five met all eligibility criteria. Combining with the prior review gave 23 interventions from 18 studies. RI in adherence ranged from 1.11 to 4.65. Six-month intervention costs ranged from $10 to $142 per patient. Reminders had the lowest effectiveness (RI: 1.11-1.14), but were least costly ($10/6 months). Case management was most effective (RI: 1.23-4.65), but the most costly ($90-$130/6 months). CONCLUSIONS: Generally, we found a positive association between intervention costs and effectiveness. Therefore, consideration of intervention costs, along with the benefits afforded to adherence, may help guide the design and implementation of adherence-improving programs.

Cross-linguistic pause and rate phenomena in adults and adolescents.

Three groups of 40 Ss (German adolescents and American adults and adolescents) read two passages and retold them. In confirmation of O'Connell Kowal, and Hörmann (1969) for German adults, a number of pause and rate measures were significantly different for semantically ordinary or unusual passages. Comparisons among the four experiments manifested different patterns of pauses and rate across the two languages and age brackets.